POS0904 CHANGES OF PULMONARY ARTERY SYSTOLIC PRESSURE IN PATIENTS WITH INTERSTITIAL LUNG DISEASE ASSOCIATED WITH SYSTEMIC SCLEROSIS ON RITUXIMAB TREATMENT
Authors: L. Garzanova, L. P. Ananyeva, O. Koneva, O. Ovsyannikova, O. Desinova, M. Starovoytova, R. Shayakhmetova
Journal: Annals of the Rheumatic Diseases (2022)

Background Nowadays, there is already published a lot of data on the treatment of systemic sclerosis (SSc) with rituximab (RTX). Recent studies reported about improvement of skin fibrosis and interstitial lung disease associated with SSc (ILD-SSc) on RTX treatment. However, there is not enough data on changes of pulmonary artery systolic pressure (PASP) in SSc patients (pts) on RTX therapy. Objectives To evaluate changes of PASP in ILD-SSc pts on RTX therapy. Methods 30 pts with initially elevated PASP (detected as ≥35mmHg by echocardiography) were retrospectively selected from a group of 103 SSc pts who received RTX as a therapy for ILD. The mean follow-up period was 25.3±2.4 months. The mean age was 52.6 years (30-65), female-26 pts (87%), the diffuse cutaneous subset of the disease had 13 pts (43%). The mean disease duration was 7.2±6.3 years. The cumulative mean dose of RTX was 2.3±1.1 grams. All pts received prednisolone at a dose of 11.3±3.7mg/day, immunosuppressants received 47% of them. All pts were positive for ANA. An assessment of basic parameters was obtained at baseline (Point 0), after 13.6±2.7 months (Point 1) and at the end of follow-up (25.3±2.4 months - Point 2). The results at baseline and at the end of the follow-up are presented in the form of mean values. Results There was already an improvement of all main parameters at the point 1 and further - by the end of follow-up (Table 1). There was a significant decrease in PASP, which was accompanied by the improvement of lung function - increase in forced vital capacity % predicted (FVC), stabilization of diffusion capacity for carbon monoxide % predicted (DLCO). A moderate negative statistically significant correlation was found between the PASP and FVC (r=-0,522; p=0,003). There was a significant increase in 6-minute walk distance (6-mwd), ejection fraction of left ventricular (ER), activity index (EScSG-AI) and a decrease of Rodnan skin score. Table 1. Changes of the main parameters on RTX treatment. Parameters Point 0 (baseline ) Point 1 (13.6±2.7 month ) Point 2 (25.6±2.4 month ) P Point 0-1 P Point 0-2 FVC, %, M±σ 75.6±20.1 82.5±19.2 88.2±22.5 0.01 0.002 PASP, mmHg, M±σ 48.2±13.8 44.4±12.3 39.5±11.8 0.008 0.004 DLCO, %, M±σ 42.7±16.2 42.6±15.2 44.9±15.6 NS NS ER, %, M±σ 61.6±5.5 63.5±6.2 65.8±5.7 0.02 0.01 Rodnan skin score, M±σ 11.1±12.4 7.2±8.1 6.1±7.6 0.003 0.0001 6-mwd, m, M±σ 419.6±103 453.8±85 458.8±78.4 0.02 0.02 Activity index (EScSG-AI), M±σ 3.3±1.5 1.5±1.3 1.4±1.1 0.001 0.001 Cumulative mean dose of RTX, g, M±σ - 1.65±0.69 2.3±1.1 - - Conclusion In our study, the PASP significantly decreased already in a year after initiation of RTX therapy and further there was an improvement of this parameter at the end of the observation. Decrease of PASP correlated with an increase of FVC and was accompanied by an increase of 6-minute walk distance, ejection fraction of left ventricular, improvement of Rodnan skin score and disease activity index. RTX could be considered as a potentially effective in combined treatment of ILD-SSc, complicated with pulmonary hypertension. Disclosure of Interests None declared